PWM: Eating Behaviors of Children (2006)
To categorize U.S. adolescents’ meal patterns and related differences in dietary quality.
Recruitment
- Not described in this paper.
Design
- Nationally representative data from 1989-1991 CSFII using a multistage, stratified sample design of the 48 coterminous states and Washington, DC.
Statistical Analysis
- Sample weights used to allow for generalization to the entire U.S. adolescent population
- Differences in nutrient intake between meal pattern categories calculated by regressions
- Multivariate analysis of determinants of meal pattern type using logistic regression techniques; model trimmed by dropping nonsignificant terms (terms not significant: northeast region, west region, central city residence, female head of household, employment status, household size, supplement use, BMI).
- No blinding.
Independent Variables
- Eating occasion
- Defined according to name given by respondent: Breakfast, lunch, dinner or snack
- Supper counted as dinner; if supper and dinner, then dinner counted as lunch
- Brunch not included because only 1.4% of all eating occasions (do not say if then classified as lunch or breakfast).
- Meal pattern categories:
- Consistent: Two or three meals with or without snacks on all three days
- Moderately consistent: Two or three meals with or without snacks on two of three days
- Inconsistent: One meal with or without snacks, or snacks only, on all three days.
[Note: One 24-hour recall and two one-day food records by female HOH for children under 12 years of age; meal patterns did not differ between children aged 11 and 12 years.]
Dependent variables
- Age
- Gender
- Ethnicity
- Region of residence
- Supplement use
- School attendance
- Educational and employment status of female HOH
- Income status (poverty percentage) of household
- School-based meal consumption
- BMI (self-reported weight and height)
- Single- vs. dual-parent household
- Nutrient percentage RDA
- Diet Quality Index Score (DQI) based on eight food- and nutrient-based recommendations from the National Academy of Sciences.
Control variables
- See above for variables tested, but not included and the results section for ones included in final model.
- N: 1,310
- Age: 11-18 years
- Ethnicity: Not specified
- Other demographics: Not specified.
Meals Pattern Category
- Consistent: 41%
- Moderately consistent: 55.5%
- Inconsistent: 3.5%
- Consistent meal pattern in bivariate (no control) analyses had significantly:
- More male subjects
- More white subjects
- More female heads of household who attended college
- More subjects who attended school
- More larger households
- More single-parent households
- Fewer weight-reducing diets
- More subjects with lower BMI (20.8 in consistent, 21.5 in moderately consistent, 22.4 in inconsistent; consistent differs from other two (P<0.05)
[Note: Nutrient and food group and DQI analyses also reported in paper.]
Greater Risk of Inconsistent Meal Pattern (in multivariate analysis)
[Note: BMI did not remain in final model.]- Older (15-18 years of age)
- Male
- Black
- Single-parent household
- Not attending school
- Not consuming school breakfast
- Not consuming school lunch
- Less than 185% of poverty.
Adolescents who consume at least two meals (with or without snacks) on a consistent basis have an adequate intake of calories and a more nutrient-dense diet with respect to calcium, iron, vitamin E and fiber than those with other meal patterns. From the perspective of following a diet to prevent chronic diseases in adulthood, adolescents regardless of meal pattern, consume a diet that is too high in fat, sodium and protein and too low in fiber.
We need to understand how adolescents define a meal and a snack. Another issue to consider is how meal patterning affects obesity, if at all. Do inconsistent meal patterns increase the likelihood of being obese or is there a set of factors that affect both meal pattern choices and the constellation of factors that contribute to obesity? Further research is needed to explore these topics.
Strengths
- Large sample size
- Nationally representative
- Control for several confounders
- Described how defined eating occasions.
Weaknesses
- Self-reported weight and height
- Not clear how or why study used meal pattern categories.
Quality Criteria Checklist: Primary Research
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Relevance Questions | |||
1. | Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) | N/A | |
2. | Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? | Yes | |
3. | Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? | Yes | |
4. | Is the intervention or procedure feasible? (NA for some epidemiological studies) | N/A | |
Validity Questions | |||
1. | Was the research question clearly stated? | Yes | |
1.1. | Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? | Yes | |
1.2. | Was (were) the outcome(s) [dependent variable(s)] clearly indicated? | Yes | |
1.3. | Were the target population and setting specified? | Yes | |
2. | Was the selection of study subjects/patients free from bias? | Yes | |
2.1. | Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? | Yes | |
2.2. | Were criteria applied equally to all study groups? | Yes | |
2.3. | Were health, demographics, and other characteristics of subjects described? | Yes | |
2.4. | Were the subjects/patients a representative sample of the relevant population? | Yes | |
3. | Were study groups comparable? | N/A | |
3.1. | Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) | N/A | |
3.2. | Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? | N/A | |
3.3. | Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) | N/A | |
3.4. | If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? | N/A | |
3.5. | If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) | N/A | |
3.6. | If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? | N/A | |
4. | Was method of handling withdrawals described? | No | |
4.1. | Were follow-up methods described and the same for all groups? | N/A | |
4.2. | Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) | N/A | |
4.3. | Were all enrolled subjects/patients (in the original sample) accounted for? | N/A | |
4.4. | Were reasons for withdrawals similar across groups? | N/A | |
4.5. | If diagnostic test, was decision to perform reference test not dependent on results of test under study? | N/A | |
5. | Was blinding used to prevent introduction of bias? | No | |
5.1. | In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? | N/A | |
5.2. | Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) | N/A | |
5.3. | In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? | N/A | |
5.4. | In case control study, was case definition explicit and case ascertainment not influenced by exposure status? | N/A | |
5.5. | In diagnostic study, were test results blinded to patient history and other test results? | N/A | |
6. | Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? | Yes | |
6.1. | In RCT or other intervention trial, were protocols described for all regimens studied? | N/A | |
6.2. | In observational study, were interventions, study settings, and clinicians/provider described? | N/A | |
6.3. | Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? | N/A | |
6.4. | Was the amount of exposure and, if relevant, subject/patient compliance measured? | N/A | |
6.5. | Were co-interventions (e.g., ancillary treatments, other therapies) described? | N/A | |
6.6. | Were extra or unplanned treatments described? | N/A | |
6.7. | Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? | N/A | |
6.8. | In diagnostic study, were details of test administration and replication sufficient? | N/A | |
7. | Were outcomes clearly defined and the measurements valid and reliable? | No | |
7.1. | Were primary and secondary endpoints described and relevant to the question? | Yes | |
7.2. | Were nutrition measures appropriate to question and outcomes of concern? | Yes | |
7.3. | Was the period of follow-up long enough for important outcome(s) to occur? | N/A | |
7.4. | Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? | No | |
7.5. | Was the measurement of effect at an appropriate level of precision? | No | |
7.6. | Were other factors accounted for (measured) that could affect outcomes? | Yes | |
7.7. | Were the measurements conducted consistently across groups? | Yes | |
8. | Was the statistical analysis appropriate for the study design and type of outcome indicators? | Yes | |
8.1. | Were statistical analyses adequately described and the results reported appropriately? | Yes | |
8.2. | Were correct statistical tests used and assumptions of test not violated? | Yes | |
8.3. | Were statistics reported with levels of significance and/or confidence intervals? | Yes | |
8.4. | Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? | N/A | |
8.5. | Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? | Yes | |
8.6. | Was clinical significance as well as statistical significance reported? | Yes | |
8.7. | If negative findings, was a power calculation reported to address type 2 error? | N/A | |
9. | Are conclusions supported by results with biases and limitations taken into consideration? | Yes | |
9.1. | Is there a discussion of findings? | Yes | |
9.2. | Are biases and study limitations identified and discussed? | Yes | |
10. | Is bias due to study's funding or sponsorship unlikely? | No | |
10.1. | Were sources of funding and investigators' affiliations described? | Yes | |
10.2. | Was the study free from apparent conflict of interest? | No | |